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NPI Code Detail

MEDICARE: CARLA A. NICKLE D.O.

MEDICARE: CARLA A. NICKLE D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician2154TN

General Provider Information

NPI Number : 1508919911
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARLA A. NICKLE D.O.
Provider Business Mailing Address
First Line : 1225 E WEISGARBER RD
Second Line : SUITE 200
City : KNOXVILLE
State : TN
Zip : 37909-2604
Country : US
Telephone Number : 865-584-4747
Fax Number : 865-584-1363
Provider Business Practice Location Address
First Line : 555 JUSTIS DR
Second Line :
City : GREENEVILLE
State : TN
Zip : 37745-4288
Country : US
Telephone Number : 423-783-7965
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2007
Last Update Date : 04/17/2018

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Directions to “ CARLA A. NICKLE D.O.” Practice Location

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